Comparison of Direct and Indirect Laryngoscopes in Vomitus and Hematemesis Settings: A Randomized Simulation Trial
Open accessAbstract
Background.Videolaryngoscopes may not be useful in the presence of hematemesis or vomitus. We compared the utility of the Macintosh laryngoscope (McL), which is a direct laryngoscope, with that of the Pentax-AWS Airwayscope (AWS) and McGRATH MAC (McGRATH), which are videolaryngoscopes, in simulated hematemesis and vomitus settings.Methods.Seventeen anesthesiologists with more than 1 year of experience performed tracheal intubation on an adult manikin using McL, AWS, and McGRATH under normal, hematemesis, and vomitus simulations.Results.In the normal setting, the intubation success rate was 100% for all three laryngoscopes. In the hematemesis settings, the intubation success rate differed significantly among the three laryngoscopes (P=0.021). In the vomitus settings, all participants succeeded in tracheal intubation with McL or McGRATH, while five failed in the AWS trial with significant difference (P=0.003). The intubation time did not significantly differ in normal settings, while it was significantly longer in the AWS trial compared to McL or McGRATH trial in the hematemesis or vomitus settings (P<0.001, compared to McL or McGRATH in both settings).Conclusion.The performance of McGRATH and McL can be superior to that of AWS for tracheal intubation in vomitus and hematemesis settings in adults.
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Most of the literature comparing DL with VL in the bloody or vomitus-filled airway is simulation-based, and concern exists about the vulnerability of VL camera lens in the contaminated airway.
“Most of the literature comparing DL with VL in the bloody or vomitus-filled airway is simulation-based, and concern exists about the vulnerability of VL camera lens in the contaminated airway.55,56”
From Airway Management in Trauma (2018) · cites this paper as [56]
The Methods describe a manikin simulation using simulated vomitus and blood, and the Discussion reports that the AWS video monitor was severely disturbed by both contaminants. The Conclusion calls for trials in actual patients. These passages support the simulation example and the concern about a contaminated video view, but do not establish that most of the literature is simulation-based or specifically identify the camera lens as the vulnerable component. Page numbers are unavailable in our copy. (LLM, conf=0.87)
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Kovacs, G., & Sowers, N. (2018) · Emergency Medicine Clinics of North America · doi:10.1016/j.emc.2017.08.006 · Cited by 115 · see citing works
- Authors
- Mihara, R., Komasawa, N., Matsunami, S., & Minami, T.
- Affiliations
- Department of Anesthesiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, Japan
- Corresponding author
- Komasawa, Nobuyasu
- Venue
- BioMed Research International
- Publisher
- Hindawi Limited
- Published
- 2015
- Volume
- 2015
- Pages
- 1-6
- ISSN
- 1110-7243 (ISSN-L)
- 2314-6133
- 2314-6141
- PMC
- PMC4651703
- OpenAlex
- W2182806151
- Cited by
- 25
- References
- 0
- Citations by year
- 2024: 3 · 2023: 1 · 2022: 2 · 2020: 2 · 2018: 4 · 2017: 6 · 2016: 7
- FWCI
- 6.81
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- BioMed Research International (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Tracheal and airway disorders
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Keywords
- endotracheal intubation, video laryngoscopy, direct laryngoscopy, Macintosh laryngoscope, hematemesis, intubation success rate, intubation time, airway management
- MeSH terms
- Child, Equipment Design, Female, Hematemesis, Humans, Intubation, Intratracheal, Laryngoscopy, Manikins, Time Factors, Vomiting, Cross-Over Studies, Laryngoscopes
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